Eli Lilly, Allergan and Biohaven have a lot riding on their forthcoming migraine launches, and now cost-effectiveness watchdog ICER has come out with some less-than-stellar findings from data supporting the drugs.

The Institute for Clinical and Economic Review’s new draft report on Eli Lilly’s Reyvow, Allergan’s ubrogepant and Biohaven’s rimegepant concludes with “moderate certainty” the drugs provide a “small or substantial” health benefit for patients who can’t take or haven’t responded to triptans, a class of older migraine treatments.

But for those who can, ICER rated ubrogepant and rimegepant as “comparable or inferior” to the existing meds. And Lilly’s Reyvow is likely to perform worse than the existing options, the group said.

Eli Lilly won FDA approval for Reyvow last month, but the drugmaker can’t launch until it receives Drug Enforcement Agency classification for the new med. The company hasn’t released the drug’s list price.

And that number, of course, is a key variable. “Pricing of these drugs will determine whether they are cost-effective at commonly used thresholds in patients who cannot take triptan medications,” the report added.

Going by expected pricing for the new meds, ICER concluded triptans would “provide a greater benefit at a lower total cost,” at least for those who respond and can tolerate them.

Importantly, the report is in draft form and subject to change as the assessment continues.

Biohaven CEO Vlad Coric said via email that more than 4 million patients don’t respond to triptans or can’t take those medicines due to CV risks. He said a new option “such as Rimegepant clearly will be an important addition to these patients.”

Further, ICER’s report didn’t emphasize that Biohaven ran a head-to-head trial comparing rimegepant against sumatriptan, Coric said. The study found a “clear advantage” for Biohaven’s drug 48 hours after treatment without having to redose and without adverse effects.


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